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Radio frequency radiation-related cancer: assessing causation in the occupational/military setting Michael Pelega, , Or Nativb, Elihu D. Richterb ⁎

a b

Dept. Electrical Engineering, Technion – Israel Institute of Technology, Technion City, Haifa 3200003, Israel and Rafael Ltd. POB 2250, Haifa 3102102, Israel Unit of Occupational and Environmental Medicine, Hebrew University-Hadassah School of Public Health and Community Medicine, POB 12272 Jerusalem Israel

A R T I C L E I N F O

A B S T R A C T

Keywords: Radio frequency radiation Non-ionizing radiation Radar Human carcinogen Hematolymphatic cancers Multiple primaries

Background and aim: We reexamine whether radio frequency radiation (RFR) in the occupational and military settings is a human carcinogen. Methods: We extended an analysis of an already-reported case series of patients with cancer previously exposed to whole-body prolonged RFR, mainly from communication equipment and radar. We focused on hematolymphatic (HL) cancers. We used analysis by percentage frequency (PF) of a cancer type, which is the proportion of a specific cancer type relative to the total number of cancer cases. We also examined and analyzed the published data on three other cohort studies from similar military settings from different countries. Results: The PF of HL cancers in the case series was very high, at 40% with only 23% expected for the series age and gender profile, confidence interval CI95%: 26–56%, p < 0.01, 19 out of 47 patients had HL cancers. We also found high PF for multiple primaries. As for the three other cohort studies: In the Polish military sector, the PF of HL cancers was 36% in the exposed population as compared to 12% in the unexposed population, p < 0.001. In a small group of employees exposed to RFR in Israeli defense industry, the PF of HL cancers was 60% versus 17% expected for the group age and gender profile, p < 0.05. In Belgian radar battalions the HL PF was 8.3% versus 1.4% in the control battalions as shown in a causes of deaths study and HL cancer mortality rate ratio was 7.2 and statistically significant. Similar findings were reported on radio amateurs and Korean war technicians. Elevated risk ratios were previously reported in most of the above studies. Conclusions: The consistent association of RFR and highly elevated HL cancer risk in the four groups spread over three countries, operating different RFR equipment types and analyzed by different research protocols, suggests a cause-effect relationship between RFR and HL cancers in military/occupational settings. While complete measurements of RFR exposures were not available and rough exposure assessments from patients interviews and from partial exposure data were used instead, we have demonstrated increased HL cancers in occupational groups with relatively high RFR exposures. Our findings, combined with other studies, indicate that exposures incurred in the military settings evaluated here significantly increased the risk of HL cancers. Accordingly, the RFR military exposures in these occupations should be substantially reduced and further efforts should be undertaken to monitor and measure those exposures and to follow cohorts exposed to RFR for cancers and other health effects. Overall, the epidemiological studies on excess risk for HL and other cancers together with brain tumors in cellphone users and experimental studies on RFR and carcinogenicity make a coherent case for a cause-effect relationship and classifying RFR exposure as a human carcinogen (IARC group 1).

1. Introduction and background

1.2. Types of exposure

1.1. The scope

Radio frequencies comprise the band of 30 kHz to 300 GHz. This includes microwaves covering the 1–100 GHz band. The major uses of RFR in the military are radio communications, radar for surveillance and weapon guidance, and electronic warfare transmitted to disrupt communications and radar. Exposures to the whole body or major parts of the body of operators and bystanders occur from a normal operation

This paper examines whether exposure to radio frequency radiation (RFR) is a human carcinogen. We focus on occupational/military settings.

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Corresponding author. E-mail addresses: [email protected] (M. Peleg), [email protected] (E.D. Richter).

https://doi.org/10.1016/j.envres.2018.01.003 Received 4 December 2017; Accepted 6 January 2018 ‹(OVHYLHU,QF$OOULJKWVUHVHUYHG